Effects of different root canal preparation methods on root fracture resistance:A systematic review of the literature

AIM: To study the root fracture resistance after root canal preparation with Ni-Ti rotary instruments and stainless hand instruments by means of meta-analysis.METHODS: Literature was researched in CNKI and CBMDisc, Pub Med, CALIS, Proquest, Web of Scienceand 11 kinds of Chinese or English dentistry journals. Retrieval time on Internet was in all years and hand retrieval time was from January 2013 to October 2013. The literatures were selected through reading abstracts and full texts by two reviewers independently and Revman 5 software was used to analysize the literature. RESULTS: Six articles met the inclusion criteria. According to Meta-analysis of tooth root bending properties, total standardized mean difference(SMD) was 0.63(95%CI:-0.24-1.50, P > 0.05). That indicated there was no statistically significant between the two groups. Subgroup analysis was carried out. SMD were 2.22(95%CI: 0.23-4.20, P < 0.05) and-0.61(95%CI:-1.05--0.17, P < 0.05) when the premolar teeth with a single canal or the mesiobuccal roots of molars were used as the materials for tests to compare the effects of different root canal preparation methods on root fracture resistance. That only indicated that there were statistically significant in two subgroups.CONCLUSION: In vitro experiments, the effects on the fracture resistance of root had no statistical difference with Ni-Ti rotary instruments and stainless steel hand instruments in root canal preparation.

Which treatment protocol, among classical methods and/or various laser applications is the most effective in root canal disinfection, <i>in vitro</i>? A systematic review

Purpose: The aim of this systematic review was to answer the question “Which treatment protocol, am- ong classical methods and/or various laser applica- tions is the most effective in root canal disinfection, in vitro”. Materials and Methods: A MEDLINE, a Co- chrane and an Embase search (three specified search- es) were conducted to identify randomized controlled trials (RCT) until June 2010, conducted on human teeth and published in English, German or French language, examining the root canal disinfection after the use of lasers with or without mechanical instru-mentation. Additionally, hand search was conducted and contact with authors, when needed. Results: The MEDLINE, the Cochrane and the EMBASE search identified 240, 28, and 35 published articles, respec-tively. Ten articles from the MEDLINE and 5 articles from the Cochrane search (that were also identified in the MEDLINE search) met the inclusion and va-lidity assessment criteria. In E. faecalis elimination, instrumentation of the root canal and diode laser/665 nanometer/1 Watt (diode laser/665 nm/1 W) irradia-tion with the combined effect of Methylene Blue (MB) as photosensitizing agent (logCFU/ml = 1636) seemed to be the best method. In P. aeruginosa and in A.naeslundii elimination, instrumentation of the root canal followed by irrigation with 5, 25% NaOCl (log-CFU/ml = 0) seemed to be the best method. In gen-eral, instrumentation of the root canal followed by irrigation with 5, 25% NaOCl (logCFU/ml = 0) and instrumentation of the root canal and Er: YAG laser/ 2940 nm/0.8 W irradiation (logCFU/ml = 1924) seemed to be the best (polymicrobial studies). Conclusions: There are treatment protocols with the assistance or not of laser irradiation that can eliminate E. faecalis, E. coli and S. aureus inside the root canal. However, there is a serious number of S. anginosus, F. nuclea-tum, A. naeslundii and P. aeruginosa that remain in-side the root canal even after laser irradiation. New research is needed in order to set a treatment proto-col effective in the root canal disinfection from all bac-teria that are related to endodontic origin pathology.

牙体牙髓病根管治疗应用iRoot SP冷侧法的效果

目的探讨牙体牙髓病根管治疗应用iRoot SP冷侧法的效果。方法筛选2018-06至2020-06在解放军总医院京南医疗区就诊的牙体牙髓病患者100例,随机分为对照组和试验组,每组50例,均进行根管治疗,其中对照组充填根管采用热牙胶垂直加压法,试验组采用iRoot SP冷侧法。比较两组根管充填效果、临床总有效率、疼痛视觉模拟评分(VAS)及咀嚼功能。结果两组治疗后根管充填效果和临床总有效率比较,差异无统计学意义(P>0.05);试验组治疗后1周[(4.13±0.79)vs.(5.11±0.98)]及1个月[(2.45±0.37)vs.(3.11±0.67)]VAS评分低于对照组,治疗后咬合力[(131.25±11.21)lbs vs.(120.34±14.09)lbs]及咀嚼效率[(90.12±4.13)%vs.(78.98±7.45)%]均优于对照组,差异均有统计学意义(P<0.05)。结论根管治疗牙体牙髓病中应用iRoot SP冷侧法的充填效果和疗效与热牙胶垂直加压法基本相同,但iRoot SP冷侧法在减轻患者疼痛,改善咀嚼功能方面更具优势。

Tooth anatomy risk factors influencing root canal working length accessibility

The aim of this study was to analyze the specific influence of root canal anatomy on the accessibility of working length during root canal therapy. Four hundred seventy-six root canal therapy cases （amounting to a total of 1 005 root canals） were examined. The anatomy risk factors assessed in each case included： tooth type （tooth location）, root canal curvature, and root canal calcification, as well as endodontic retreatment. The investigation examined the correlation between each of these anatomic factors and the working length, with statistical analysis consisting of Chi-square tests and multiple logistic regression analysis. In an independent factor analysis, tooth type （tooth iocation）, root canal curvature, canal calcification, and endodontic retreatment were determined to be the primary risk factors. In a multiple-factor regression model, root curvature and canal calcification were found to most significantly influence root canal working length accessibility （P〈0.05）. Root canal anatomy increases the difficulty of root canal preparation. Appropriate consideration of tooth anatomy will assist in accurate determination of preparation difficulty before instrumentation. This study alerts clinical therapists to anatomical factors influencing the working length accessibility, and allows for a direct estimate of success rate given in situ measurements of tooth factors during the root canal treatment procedure.

Efficacy of Solution Form of Ethylenediaminetetraacetic Acid on Removing Smear Layer of Root Canal at Different Exposure Time In Vitro

Summary： This study was aimed to evaluate the effectiveness of solution form of 17% ethylenediaminetetraacetic acid （EDTA） on removing smear layer of root canals at different exposure time periods and to provide scientific basis for EDTA as a choice of root canal irrigation in clinical practice. Twenty-five single-rooted teeth were randomly divided into 5 groups： control group （group A） was given 2.5% NaOC1, and 4 experimental groups were given 2.5% NaOC1 and 17% EDTA, including groups B, C, D and E with exposure time of 1, 3, 5 and 7 min, respectively. After preparation of the root canals, the teeth were split along their longitudinal axis, and the root sections were examined under scanning elec- tron microscope for evaluation of smear layer removal and erosion on the surface of the root canal walls. The specimens in group B showed presence of smear layer on the walls of the root canal with no statistical difference from that in group A （P〉0.05）. In groups C and D, partial removal of smear layer was obtained, and there was no significant difference between the two groups （P〉0.05）, but there was significant difference in removal of smear layer between group C and group B （P〈0.05）. Root canal walls in group E specimens showed almost complete removal of smear layer, and the removal of smear layer was significantly different from that in group D （P〈0.01）. There was no significant change in the structure of the surface of root canal for each sample. It was concluded that combined irrigation with 17% EDTA and 2.5% NaOC1 could remove the smear layer with no significant alteration in dentinal structure when the chelating agent was applied for 7 min. At 3 and 5 min of application, partial removal of smear layer was observed and at 1 min negligible removal of smear layer was achieved.

C形根管充填治疗恒牙根尖周炎中采用热牙胶垂直加压法与iRoot SP冷侧压法的临床效果分析

目的分析C形根管充填治疗恒牙根尖周炎中采用热牙胶垂直加压法与iRoot SP冷侧压法的临床疗效。方法简单随机选择2019年6月—2021年12月烟台业达医院收治的60例恒牙根尖周炎患者作为研究对象,依据不同治疗方法分为两组,每组30例。两组患者均进行C形根管充填治疗,对照组采用热牙胶垂直加压法,观察组采用iRoot SP冷侧压法,比较两组患者临床疗效、填充效果、牙周指数。结果观察组治疗总有效率为100.00%(30/30),高于对照组的80.00%(24/30),差异有统计学意义(χ^(2)=4.630,P=0.031)。两组患者填充效果比较,差异无统计学意义(P>0.05)。治疗后10周,观察组出血指数、菌斑指数、牙龈指数、牙周袋深度均低于对照组,差异有统计学意义(P均<0.05)。结论在C形根管充填治疗恒牙根尖周炎患者中采用iRoot SP冷侧压法能提升临床疗效,改善牙周指数。

根管锉尖直径对Root ZX测量仪准确性影响的研究

目的：研究根管预备时根管锉尖直径对Root ZX根管长度测量仪精确度的影响。方法：40颗正畸减数离体下颌前磨牙，15#不锈钢根管锉测量预备前根管的真实长度。K锉分别根管预备至主锉为40#（常规预备）和60#（过度预备），离体牙植入20g／L的琼脂生理盐水凝胶中，15—40#和15～60#K锉分别再次测量预备后根管的工作长度。所有测量值进行方差分析。结果：根管锉尖直径和根管扩大程度对测量仪的准确性有显著性影响（P〈0．05），最大测量值差别为0．22mm。结论：根管预备完成后，使用锉尖直径较小的根管锉会使电测根管工作长度变小，根管预备完成后或根充前应选用与根管直径匹配的根管锉再次确认根管工作长度。

iRoot SP配合单尖法根管充填治疗牙体牙髓病的效果及对牙周状态和龈沟液炎性因子水平的影响

目的 探讨iRoot SP配合单尖法根管充填治疗牙体牙髓病的效果及对牙周状态和龈沟液炎性因子水平的影响。方法 选取2020年1月—2022年1月收治的牙体牙髓病82例,按治疗方法分为观察组和对照组各41例,观察组应用iRoot SP配合单尖法治疗,对照组应用iRoot SP配合冷测压法治疗。比较2组临床疗效、充填情况、牙周状态、龈沟液炎性因子水平及疼痛情况。结果 治疗后,观察组临床总有效率和恰填率高于对照组(P<0.05)。观察组治疗后牙周探诊深度、探诊出血指数、牙齿松动度、菌斑指数、临床附着水平及超敏C反应蛋白、肿瘤坏死因子-α、白细胞介素-1β均低于对照组(P<0.05,P<0.01)。治疗后,观察组疼痛总发生率低于对照组(P<0.05)。结论 iRoot SP配合单尖法根管充填能够提高牙体牙髓病的临床疗效,改善患者充填情况以及牙周状态,降低龈沟液炎性因子水平及减轻患者疼痛。

iRoot SP用于直根管桩腔预备后根尖封闭性的研究

目的:评价iRoot SP对直根管桩腔预备的根尖封闭效果。方法:选取73颗离体直根管牙随机分为8组。A1和B1、A2和B2、A4组分别用AH Plus、iRoot SP、ZOE+热牙胶根充,A3组iRoot SP+单尖根充。C、D组为阳、阴性对照。A1-A4组行即刻桩腔预备; B1、B2组行延迟桩腔预备。染色后透明牙技术评价根尖微渗漏情况。结果:各组染料渗透深度比较A1、A2、A3组间,A1与B1,A2与B2组间比较无统计学意义(P> 0. 05),A4组和C组渗透长度大于A2组(P <0. 05)。结论:iRootSP和AH Plus的根尖封闭性能相同; iRoot SP结合热牙胶充填和结合单尖充填后即刻桩腔预备的根尖封闭性无明显差异。

iRoot SP冷侧法在C型根管填充治疗牙体牙髓病中的咀嚼功能及对疼痛程度的影响

目的:探讨iRoot SP冷侧法在C型根管填充治疗牙体牙髓病中的效果、咀嚼功能及对疼痛程度的影响。方法:选择2018年10月-2019年10月笔者医院收治的82例牙体牙髓病患者,随机分为对照组和观察组,每组41例,均接受C型根管填充治疗。观察组接受iRoot SP冷侧法,对照组接受AH plus加热牙胶垂直加压法,观察两组的临床效果、咀嚼能力及咬合相关指标、疼痛程度、术后并发症情况并进行比较。结果:观察组治疗有效率为95.12%,对照组治疗有效率为75.61%,两组比较差异有统计学意义(P<0.05);治疗后,两组患者咀嚼功能、咬合能力、牙龈指数及出血指数相较于治疗前有所改善,但观察组均优于对照组(P<0.05);观察组患者治疗1周及30 d后疼痛评分明显低于对于对照组(P<0.05);观察组并发症发生率为7.32%,明显低于对照组的21.95%,差异有统计学意义(P<0.05);两组患者治疗后1周及30 d随访,观察组的牙齿咀嚼功能、牙龈指数、咬合力及松动度等指标均优于对照组,差异有统计学意义(P<0.05)。结论:iRoot SP冷侧法在C型根管填充中治疗牙体牙髓病效果显著,能提高咀嚼功能,缓解术后疼痛,提高患者生活质量。

Fracture resistance and pattern of the upper premolars with obturated canals and restored endodontic occlusal access cavities

We studied whether obturing canals and restoring endodontic occlusal access cavities on upper premolars could provide acceptable resistance and pattern to fracture.Eighteen upper premolars were divided equally into 3 groups.Group 1 consisted of intact controls;group 2 had access cavities and root canal preparations;group 3 as in group 2 but obturated with gutta-percha and AH26,and the access cavity restored with glass ionomer and composite.Specimens were submitted to compressive strength testing using the Hounsfield Universal H50KM testing machine with a load cell of 2000 Newtons and a crosshead speed set at 1.0 mm/min until fracture.The results from the compressive strength tests showed that intact controls （1105.83±90.93 MPa） and restored premolars （936.67±44.67 MPa） were significantly different from premolars with unrestored access cavities 568.33±105.49 MPa.There was no significant difference between intact controls and restored premolars.The predominant fracture pattern for intact teeth was an oblique fracture.For premolars that had endodontic access cavities,restored or unrestored,the most common fracture pattern was a vertical fracture.The restoration of occlusal access cavities with glass ionomer and composite provided fracture resistance close to that of intact controls,but when restored teeth fractured,they were predominantly non-restorable.

冷侧压法、垂直加压法及iRoot SP糊剂单尖法的根管充填疗效评价

目的评价全科医生使用AH-Plus糊剂冷牙胶侧压法、iRoot SP糊剂单尖法和AH-Plus糊剂热牙胶垂直加压法的根管充填疗效。方法将2019年6—12月福建医科大学附属福州市第一医院口腔科和南京医科大学附属口腔医院第四门诊部全科医生治疗的磨牙患者按根管充填方法分为A组(冷侧压法)、B组(iRoot SP糊剂单尖法)、C组(垂直加压法),每组各40颗患牙。评价根管充填时间、术后7 d疼痛率、充填质量和半年随访疗效。结果102例患者的116颗患牙中,A组平均每个根管充填时间为(138.27±22.24)s,B组为(56.55±6.21)s,C组为(74.10±7.36)s,差异有统计学意义(P<0.05)。三组疼痛率(13.5%、5.0%、17.9%)比较差异无统计学意义(P>0.05)。三组根管充填质量(89.2%、92.5%、89.7%)和半年随访成功率(89.2%、97.5%、94.9%)比较差异无统计学意义(P>0.05)。结论三组方法均能取得良好疗效,但iRoot SP糊剂单尖法操作简便,更利于全科医生开展复杂根管治疗。

Root ZX根管长度测量仪的应用研究进展

根管治疗术是治疗牙髓病、根尖周病首选的方法,而根管工作长度的准确测定是完善根管治疗的关键,采用Root ZX测量根管工作长度是目前临床上使用较多的一种准确测量的方法。本文对影响Root ZX测量的因素及其临床应用进行了阐述,说明Root ZX能准确测定根管工作长度,从而提高了根管治疗的效果,具有广泛的临床应用前景。

iRoot SP冷侧压法在恒牙根尖周炎根管填充中的应用效果及对牙周指标的影响

目的:探讨根管充填材料(iRoot SP)冷侧压法在恒牙根尖周炎根管填充中的应用效果及对牙周指标的影响。方法:选取2019年10月-2022年5月济宁市中医院收治的302例恒牙根尖周炎患者,应用随机数字表法将其分为观察组(n=151)和对照组(n=151)。对照组接受热牙胶垂直加压法进行根管填充治疗,观察组接受iRoot SP冷侧压法进行根管填充治疗。对比两组填充效果、临床效果、治疗前后疼痛程度、牙周指数、复发率。结果:两组填充效果比较,差异无统计学意义(P>0.05);观察组治疗总有效率(96.69%)高于对照组(89.40%)(P<0.05)。治疗前,两组视觉模拟评分法(visual analogue scale,VAS)评分比较,差异无统计学意义(P>0.05);治疗后,两组VAS评分均下降,观察组低于对照组(P<0.05)。治疗前,两组牙龈指数、菌斑指数、出血指数、牙周袋深度比较,差异均无统计学意义(P>0.05);治疗后,两组各项指数均降低,观察组均低于对照组(P<0.05)。对照组复发率(7.62%)高于观察组(1.80%)(P<0.05)。结论:iRoot SP冷侧压法在恒牙根尖周炎根管填充中效果显著,可降低术后疼痛及患牙松动程度,改善牙周指标,降低复发率,预后较佳。

Reciproc单支锉清除iRoot SP糊剂单尖法根管充填材料的再治疗效率研究

目的以AH糊剂冷侧压法、热牙胶垂直加压法为对照,口腔锥形束CT(CBCT)三维重建评价使用Reciproc单支锉去除iRoot SP糊剂单尖法术后根管充填材料的再治疗效率。方法选择福建医科大学附属福州市第一医院口腔科2021年7—11月正畸拔除的卵圆形单根管下颌前磨牙90个,采用随机数表法分为iRoot SP糊剂单尖法组(1组)、热牙胶垂直加压组(2组)和AH糊剂冷侧压组(3组)。使用Reciproc单支锉再治疗,终末超声荡洗2 min。分别于根充术后、再治疗、超声荡洗后CBCT扫描并三维重建,记录再治疗时间、根管残余充填材料体积。结果1组再治疗耗时最长,2组最短,差异有统计学意义(P<0.05)。1组残余充填材料最多,大于2组,差异有统计学意义(P<0.05),大于3组,但差异无统计学意义(P>0.05)。超声荡洗后,1组残余量大幅度减少,差异有统计学意义(P<0.05);最终残余量大于2组,差异有统计学意义(P<0.05),大于3组,但差异无统计学意义(P>0.05)。结论无论哪种充填方法,Reciproc单支锉再治疗均不能完全去除充填材料。iRoot SP糊剂单尖法进行再治疗耗时最多,残余量也最多,超声荡洗能够显著减少残余量。

iRoot SP单尖法与冷侧压根管充填的疗效比较

目的比较iRoot SP单尖法与冷侧压根管充填的临床疗效。方法 60例(60颗磨牙)牙髓炎及慢性根尖周炎患者,按就诊顺序分为观察组30例(30颗磨牙)及对照组30例(30颗磨牙)。观察组采用iRoot SP单尖法充填根管,对照组采用冷侧压充填根管。比较两组单根根管充填时间、根管充填质量及术后1周疼痛情况。结果观察组单根根管充填时间为(78.25±6.51)s,对照组单根根管充填时间为(132.15±5.43)s,观察组单根根管充填时间短于对照组,差异具有统计学意(P<0.05)。观察组恰充28颗(93.33%),欠充2颗(6.67%),超充0颗(0)。对照组恰充28颗(93.33%),欠充1颗(3.33%),超充1颗(3.33%)。两组恰充率比较,差异无统计学意义(P>0.05)。观察组1例出现疼痛,疼痛率为3.33%;对照组6例出现疼痛,疼痛率为20.00%,观察组疼痛率低于对照组,差异具有统计学意义(P<0.05)。结论 iRoot SP单尖法根管充填操作简单,充填时间短,术后疼痛少,短期疗效可靠。

热牙胶垂直加压法与iRoot SP冷侧法应用于C形根管充填治疗牙体牙髓病的临床效果探讨

目的分析对比热牙胶垂直加压法与iRoot SP冷侧法行C形根管充填手术后对牙体牙髓病的治疗效果。方法在平顶山市口腔医院2017年4月—2018年4月治疗牙体牙髓病患者中选取84例,并严格按照随机分配原则分为对照组与观察组,每组各42例。对照组采用热牙胶垂直加压法充填,观察组采用iRoot SP冷侧法充填,观察对比两组患者充填效果和不良反应发生率。结果治疗后,对照组总有效率为88.09%,观察组总有效率为92.86%;对照组恰填人数为35例,观察组恰填人数为34例,对照组不良反应发生率为16.66%,观察组不良反应发生率为19.04%,以上数据组将比较差异均无统计学意义(P>0.05)。结论iRoot SP冷侧法应用于牙体牙髓病患者中治疗效果显著,具有很好的填充效果,且并发症发生率无出现升高情况,值得临床推广。

iRoot SP冷侧压法与热牙胶垂直加压法治疗牙体牙髓病患者的效果比较

目的:比较iRoot SP冷侧压法与热牙胶垂直加压法治疗牙体牙髓病患者的效果。方法:选取62例牙体牙髓病患者作为研究对象,按照随机数字表法分为观察组30例与对照组32例。两组均行C形根管充填治疗,对照组采用iRoot SP热牙胶垂直加压法,观察组采用iRoot SP冷侧压法,比较两组适填率、充填面积比、疗效和患者满意率。结果:两组适填率、充填面积比和治疗总有效率比较,差异均无统计学意义(P>0.05);观察组满意率为100%,明显高于对照组的81.25%,差异有统计学意义(P<0.05)。结论:iRoot SP冷侧压法与热牙胶垂直加压法治疗牙体牙髓病患者的效果相当,但iRoot SP冷侧压法可提高患者满意率。

iRoot SP冷侧压法与热牙胶垂直加压法在C形根管充填治疗牙体牙髓病患者中的应用效果比较

目的:比较iRoot SP冷侧压法与热牙胶垂直加压法在C形根管充填治疗牙体牙髓病患者中的应用效果。方法:选取2021年1月至2021年12月该院收治的60例牙体牙髓病患者进行前瞻性研究,按照随机数字表法将其分为对照组和观察组各30例。两组均进行C形根管充填治疗,对照组采用热牙胶垂直加压法,观察组采用iRoot SP冷侧压法,比较两组充填效果(适填率、充填面积比),随访6个月时临床疗效,治疗前和治疗后1、2、3 d疼痛程度[数字评价量表(NRS)]评分,不良反应发生率,以及随访6个月时复发率。结果:两组适填率、充填面积比、治疗总有效率比较,差异均无统计学意义(P>0.05);治疗后1、2、3 d,观察组NRS评分均低于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为10.00%(3/30),低于对照组的33.33%(10/30),差异有统计学意义(P<0.05);观察组复发率为3.45%(1/29),低于对照组的28.57%(8/28),差异有统计学意义(P<0.05)。结论:iRoot SP冷侧压法行C形根管充填治疗牙体牙髓病患者,可减轻疼痛程度,减少不良反应,降低复发率,但充填效果和临床疗效与热牙胶垂直加压法相当。

根管治疗中光动力疗法作用于粪肠球菌的优化根管预备程度的研究

目的:筛选出应用亚甲基蓝光动力疗法辅助根管消毒效果最优的根管预备程度。方法:体外孔板内构建粪肠球菌生物膜,以证实亚甲基蓝光动力疗法对粪肠球菌有杀菌作用。在离体牙根管中构建粪肠球菌生物膜,比较光动力疗法对于不同预备程度根管内粪肠球菌的清理效果。结果:体外建模证实光动力疗法可杀灭粪肠球菌。根管预备0.04锥度下,20号和25号根管组杀菌效果不如30号根管组;在25号根管组中,0.04锥度组杀菌结果不如0.06锥度组和0.08锥度组。结论:光动力疗法对根管中的粪肠球菌有明显杀菌作用,配合亚甲基蓝光动力疗法对根管内粪肠球菌进行清理的相对优化预备程度为0.04锥度30号和0.06锥度25号。